Dual diagnosis and co-occurring disorders are psychiatric disorders that are occurring along with substance abuse or substance dependence disorders.
More than half of people experiencing alcohol and drug abuse or dependence disorders are also suffering from a co-occurring mental disorder.
Diagnosing a dual diagnosis/co-occurring disorder condition in substance abusers can be difficult, as drug abuse itself often induces psychiatric symptoms. In determining the correct dual diagnosis/co-occurring disorder diagnosis it is necessary to differentiate between substance induced and pre-existing mental illness.
Self Medication and Drug or Alcohol Abuse and Dependence
Often people suffering from mental disorders attempt to deal with the problem themselves by "self medicating." It is common for people experiencing mental disorders to feel relief when drinking alcohol or taking drugs, so it is natural that they should start using these substances to alleviate or control their symptoms.
The problem with self medicating a mental disorder is that prolonged use of alcohol and recreational drugs will likely create a condition of pathological dependence. In addition, use of certain substances may actually increase the symptoms or create new symptoms.
Treatment for Dual Diagnosis/Co-Occurring Disorders
Summit Malibu's world-class therapists have decades of experience treating the many dual diagnosis/co-occurring disorders that often accompany substance dependence.
Click on the links below to learns more about treatment of dual diagnosis/co-occurring disorders, such as:
- Anxiety Disorder
- Attention Deficit Hyperactivity Disorder (ADHD)
- Bi-Polar Disorder
- Borderline Personality Disorder (BPD)
- Obsessive Compulsive Disorder (OCD)
- Panic Disorder
- Post Traumatic Stress Disorder (PTSD)
- Social Anxiety Disorder
Dexedrine (dexetroamphetamine) is a psychostimulant drug that produces increased wakefulness and focus in association with decreased fatigue and decreased appetite.
Physical effects of dextroamphetamine can include hyperactivity, restlessness, dilated pupils, blood shot eyes, dry mouth, headache, tachycardia, hypertension, fever, diarrhea, constipation, blurred vision, aphasia, dizziness, twitching, insomnia, numbness, palpitations, arrhythmias, tremors, and convulsions.
In cases of high doses or long term abuse and dependence, physical effects may include coma, stroke, heart attack, and sudden death.
Psychological effects can include euphoria, anxiety, increased libido, alertness, concentration, energy, self-esteem, self-confidence, sociability, irritability, aggression, psychosomatic disorders, psychomotor agitation, hubris, excessive feelings of power and invincibility, repetitive and obsessive behaviors, and paranoia.
In cases of high doses or long term abuse and dependence, psychological effects can include a condition known as "amphetamine psychosis."
Withdrawal symptoms from dextroamphetamine primarily consist of mental fatigue, mental depression, and an increased appetite. Symptoms may last for days with occasional use, but may last for weeks or months with chronic use. The severity of symptoms is dependent on the length of time and the amount of dextroamphetamine taken.
Withdrawal symptoms may also include anxiety, agitation, excessive sleep, vivid or lucid dreams, suicidal thoughts, and psychosis.
Dextroamphetamine (along with amphetamine and methylphenidate) has become a popular recreational stimulant drug because of its euphoric effects and its common use as a so-called "study drug." It is one of the most widely used and one of the most addictive recreational drugs available.
Treatment for Dexedrine abuse and dependence often requires medically supervised detoxification followed by concentrated psychosocial treatment.
Even short term Dexedrine abuse lasting only a few weeks or months may require medical and psychosocial treatment. Severity of withdrawal symptoms are dependent on length and frequency of use, with the most severe cases requiring months of treatment. Continued social support is usually recommended as psychological dependence lasts well after physical dependence has been successfully treated.
Summit Malibu offers the following drug addiction, drug dependence, and drug abuse tests and assessments to help people in determining the seriousness of drug and alcohol problems they may be facing.
These tests are not meant to replace a professional evaluation.
As with any potentially life-threatening medical condition, a professional medical assessment is highly recommended.
Summit Malibu is available 24 hours a day, 7 days a week to provide a no-cost, no-commitment, confidential evaluation for problems with drug and alcohol addiction and abuse.
Click the links below to view the following addiction, dependence, and abuse tests:
- Diagnostic and Statistical Manual of Mental Disorders (DSM IV)
- International Statistical Classification of Diseases (ICD 10)
- 20 Questions (Johns Hopkins)
- Alcohol Use Disorders Identification Test (AUDIT)
- Drug Abuse Screening Test (DAST)
- Michigan Alcohol Screening Test (MAST)
- Severity of Alcohol Dependence Questionnaire(SADQ)
Summit Malibu offers the following partial list of governmental resources for information on addiction and other treatment related resources.
The U.S. Government has created the following resources for addiction treatment and support.
- The National Clearinghouse for Alcohol and Drug Information (NCADI):
- Comprehensive source of information and searchable databases on substance abuse prevention.
- National Institute on Alcohol Abuse and Alcoholism(NIAAA):
- Supports and conducts research on causes, consequences, treatment and prevention of alcoholism and alcohol related problems.
- National Institute on Drug Abuse (NIDA)
- Lead the nation in bringing the power of science to bear on drug abuse and addiction.
- Office of National Drug Control Policy (ONDCP)
- Establishes policies, priorities, and objectives for the nation's drug control program.
- The Substance Abuse and Mental Health Services Administration (SAMSHA):
- Assures that quality substance abuse and mental health services are available to people in need and strives to ensure that prevention and treatment knowledge is used more effectively in the general health care system.
Borderline personality disorder (BPD) is defined "as a prolonged disturbance of personality characterized by depth and variability of moods." The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; chaotic and unstable interpersonal relationships; unstable self-image, identity, and behavior; and a disturbance in the individual's sense of self.
In extreme cases, this disturbance in the sense of self can lead to periods of dissociation, or mental breakdown.
Borderline personality disorder can have a long-term negative impact on many aspects of a person's life. This includes sometimes extreme difficulties in relationships at work, home, and in social situations. Self-harming is also a symptom, with attempted (or complete) suicide a possibility, especially without proper care and effective therapy.
The negative emotional states of BPD are grouped into four categories:
- Destructive or self-destructive feelings,
- Extreme feelings in general,
- Feelings of fragmentation or lack of identity, and
- Feelings of victimization.
Individuals suffering from BPD tend to view the world generally as dangerous and malevolent, and tend to view themselves as powerless, vulnerable, and unacceptable.
They can be very sensitive to the way others treat them, reacting strongly to perceived criticism or hurtfulness. Their feelings about others often shift from positive to negative, generally after a disappointment or perceived threat of losing someone.
Self-image can also change rapidly from extremely positive to extremely negative. Impulsive behaviors are common, including alcohol or drug abuse, unsafe sex, gambling and recklessness in general.
Individuals with BPD engage in high levels of intimacy- or novelty-seeking, and yet are very alert to signs of rejection or not being valued. They tend toward insecure, avoidant or ambivalent, or fearfully preoccupied patterns in relationships.
It is very important to locate professionals who are experienced and qualified in the treatment of borderline personality disorder.
Many professional studies recommend against the use of medication for treating BPD. Antidepressants, antipsychotics and mood stabilizers such as lithium are often used to treat co-occurring symptoms such as depression.
Dialectical Behavior Therapy (DBT) has been show to be very effective in the treatment of borderline personality disorder.
Several types of psychotherapy for BPD have developed in recent years. Studies suggest that people with BPD can benefit on at least some outcome measures. Supportive therapy alone may enhance self-esteem and mobilize the existing strengths of individuals. Psychotherapy can often be conducted either with individuals or with groups. Group therapy can aid the learning and practice of interpersonal skills and self-awareness by individuals with BPD.
Dual Diagnosis/Co-Occurring Disorder
Borderline personality disorder often occurs together with substance abuse and substance dependence disorders. Often the substance use is the result of an attempt to "self-medicate" but just as often substance dependence is the primary disorder with BDP being secondary. In either case, both disorders must be treated simultaneously to achieve an effective outcome.
Methaqualone (brand name Quaalude) is a sedative and hypnotic drug with central nervous system depressant effects similar to barbiturates. It was most commonly prescribed in the 1960s and 1970s as a treatment for insomnia, and as a sedative and muscle relaxant.
Methaqualone is currently listed as a Schedule I controlled substance in the United States.
The common side effects of Methaqualone include euphoria, drowsiness, reduced heart rate, reduced respiration, increased sexual arousal, and numbness in the fingers and toes. Large doses can cause respiratory depression, headache, and sensitivity to light.
Methaqualone overdose symptoms include delirium, convulsions, extreme muscle contractions and spasms, vomiting, renal insufficiency, coma, and death through cardiac or respiratory arrest. Methqualone overdose resembles barbiturate poisoning but with increased motor difficulties and a lower rate of cardiac or respiratory depression.
Methaqualone became a popular recreational drug in the 1960s and 1970s because it heightened sensitivity and euphoria.
Smoking Methaqualone, by itself or added to legal and illegal smoking blends, became popular in the U.S. during the mid-1970s. This created a serious health risk due to ingredients that became toxic when smoked.
Smoking Methaqualone can lead to emphysema and other chronic lung disorders including talcosis.
Nembutol (Pentobarbital) is a short-acting barbiturate that is most commonly prescribed for treatment of seizures, preoperative sedation, and other sedation. It is also sometimes prescribed for sleep disorders.
Nembutol side effects include slurred speech, shallow breathing, sluggishness, fatigue, disorientation, lack of coordination, and dilated pupils. Nembutol, like other barbiturates, mimics alcohol inebriation, causing mild euphoria, lack of inhibition, relief of anxiety, and sleepiness.
High doses of Nembutol cause impairment of memory, judgment and coordination, as well as irritability, paranoia, and suicidal ideation.
Long-term effects include tolerance which develops quickly. Larger doses are used to create the same effects, which increases the danger of an overdose. Alcohol, opoids, antihistamines, other sedative-hypnotics and other central nervous system depressants will greatly increase the sedation effects and risk of accidental death.
Pentobarbital is a drug that has been used recreationally under the slang term "yellow-jacket."
Pentobarbitol abuse can occur with recreational use, where the drug is taken to achieve a high, or out of prescription misuse, when the drug is continued long term against medical advice. Short-acting barbiturates like Nembutol are the most frequently abused barbiturates, and are often used on the street in combination with stimulants such as cocaine, amphetamines, and crystal methamphetamine.
Withdrawal symptoms include tremors, elevated blood pressure and pulse, sweating, and possible seizures.
Nembutol, especially when taken with other drugs or alcohol, can result in death due to respiratory depression.
Dextropropoxyphene, manufactured by Eli Lilly and Company, is an analgesic in the opioid category. It is used to treat mild pain and is additionally an anti-tussive and local anesthetic. It is also helpful in relieving symptoms of restless legs syndrome. Dextropropoxyphene is sometimes combined with paracetamol or acetylsalicylic acid under the trade names Darvocet and Darvon.
Dextropropoxyphene, like codeine, is an opioid that is known to cause dependency among recreational users.
Dextropropoxyphene is commonly used to ease the withdrawal symptoms in people addicted to opioids. Being very weak in comparison to the opioids that are commonly abused, dextropropoxyphene acts as a partial substitute during wthdrawal. While it does not have much effect on mental cravings, it can be effective in alleviating physical withdrawal effects.
Darvocet overdose can occur both from liver toxicity from the paracetamol poisoning and from dextropropoxyphene overdose. Many abusers experience toxic effects when increasing the dose due to tolerance. They suffer acute liver toxicity, which causes severe stomach pains, nausea, and vomiting (all of which are increased by light or stimulation of the sense of sight).
An overdose of dextropropoxyphene may lead to depression of the central nervous system, respiratory depression, miosis, and mood altering effects.
A U.S. Food and Drug Administration panel recently recommended that dextropropoxyphene be removed from the market due to its weak pain killing abilities, addictiveness, and its association with drug deaths and heart problems including arrhythmia.
Because of its potential for side effects, dextropropoxyphen is on the list for High Risk Medications in the elderly.
Darvocet addiction treatment requires a medically supervised detoxification followed by psychosocial treatment. Severe addiction may require medications to calm withdrawal symptoms and regulate disturbed brain function. After physical cravings for the drug have ended emotional dependence can be significant. Most people benefit from continued support.
Dextropropoxyphene remains one of the most abused drugs in the U.S. because it has a chemical structure similar to methadone, making it extremely difficult to end long-term abuse and dependence.
Concerta (methylphenidate) is a psychostimulant drug approved for treatment of Attention Deficit Hyperactivity Disorder, Postural Orthostatic Tachycardia Syndrome, and narcolepsy. It may also be prescribed for treatment-resistant cases of lethargy, depression, neural insult, obesity, and Obsessive Compulsive Disorder.
Methylphenidate belongs to the piperidine class of compounds, which increase the levels of dopamine and norepinephrine in the brain. Methylphenidate is structurally similar to amphetamine, and its pharmacological effects are closely related to those of cocaine.
In the United States, Concerta (methylphenidate) is classified as a Schedule II controlled substance, the designation used for substances that have a recognized medical value but present a high likelihood for abuse because of their addictive potential.
Concerta is approved by the FDA for the treatment of Attention Deficit hyperactivity disorder because of its effects of increasing or maintaining alertness, combating fatigue, and improving attention. The long term effects of methylphenidate on the developing brain are unknown, and it is not approved for children under six years of age.
Methylphenidate has shown some benefits as a replacement therapy for methamphetamine addiction. Methylphenidate and amphetamine have also been investigated as a chemical replacement for the treatment of cocaine dependence, in the same way that methadone is used as a replacement for heroin. Methylphenidate is actually more potent than cocaine in its effect on dopamine transporters.
Methylphenidate has a high potential for drug abuse and drug dependence due to its pharmacological similarity to cocaine and amphetamine.
Methylphenidate abuse is higher among college students compared to non-college attending young adults. College students abuse methylphenidate as a so-called "study drug" to improve concentration or stay awake. Methylphenidate has been dubbed "kiddie coke" due to its low price and high availability among young people. It is one of the top ten stolen prescription drugs in the United States.
Increased alcohol consumption due to abuse of stimulants such as Concerta has additional negative effects on the health, particularly in young adult abusers.
Concerta long term use, and use in high doses, has been associated with higher levels of psychiatric admissions, drug dependence, paranoia, schizophrenia and psychosis. Psychotic symptoms from Mehyphenidate can include hearing voices, visual hallucinations, urges to harm oneself, severe anxiety, euphoria, grandiosity, paranoid delusions, confusion, and increased aggression.
Tolerance may occur with long-term use of methylphenidate, including cross tolerance with other stimulants such as amphetamines and cocaine.
Withdrawal symptoms of methylphenidate can include psychosis, depression, irritability and a temporary worsening of the original symptoms for which the drug was prescribed, known as rebound.
The organizations and links below are simply resources for you to find more information, research and statistics about drugs, drug abuse, drug addiction and recovery, so that you can make your own informed and educated conclusions.
- An educational site focusing on addiction issues, especially opiate addiction and treatment.
- Dedicated to educating the public about the effects of alcohol, alcoholism and treatment.
- Publisher of prevention literature.
- Mental Illness, Drug Addiction and Alcoholism, MIDAA(R), MICA.
- Internet Clearinghouse of resources, support and information.
- Information on alcohol and the social and health consequences of its misuse.
- National resource center and meeting place for communities working to reduce substance abuse and gun violence.
- Educational resource covering all aspects of alcoholism.
- Directory of mental health resources.
- Website that answers questions about methadone and has Methadone Anonymous support.
- Information on the cost of substance abuse throughout society and its impact on our lives.
- Provides education, information, help and hope in the fight against substance abuse.
- Dedicated to promoting public and professional recognition, awareness and understanding of Sexual Addiction, Sexual Compulsivity, and Sexual Offending.
- A resource for parents, educators and professionals on inhalant abuse.
- A website and that helps people locate addiction treatment centers and drug rehabilitation programs.
- Woodbury Reports presents resources for parents and professionals trying to help at-risk teenagers.
- Educational site about why teens begin using, what they are using, and how those drugs are affecting teens physically, socially, and mentally.
- Provides accurate information about alcohol and other drug addictions. Resource for anyone needing factual information about abused drugs.